Customer Facts of Loss Form Customer Facts of Loss Form Your name Your email 1. How did the impact happen? 2. Was the vehicle in motion or parked during the incident? 3. How many passengers were in the vehicle during the incident? 4. Of those passengers how many were wearing their seat belt during the incident 5. Speed during impact if vehicle was not parked? 6. Did you feel the force of impact if vehicle is in motion? 7. Any lights come on the dash at the time of impact or after? 8. Any noises or issues with steering/alignment since? If so please explain to the best of your ability. 9. Any aftermarket equipment installed to the vehicle in the past at the area of impact? 10. Have you had paint protection film / ceramic coating applied to the body or the glass in the past? If so do you know what company/brand it is? 11. Was there a car seat in the vehicle at the time of impact? Even if not in use? a. If YES, please contact your insurance company to replace immediately even if not in use... 12. Any other information you would like to share about the incident?
